Cognitive behavioural therapy vs physio for low back pain

Psychological factors have consistently been demonstrated to be related to delayed/poor recovery in patients with chronic low back pain. Research conducted thus far to address these factors has yielded only modest results. This feasibility study aimed to address the limitations of prior studies such as delivery by non-experts and lack of individualised interventions by delivering an optimised behavioural intervention. The findings suggest that contextual cognitive behavioural therapy delivered by an expert psychologist is superior to physiotherapy alone for low back pain patients suffering from "fear avoidance".

"Avoidance" was classified by via the STarT Back Screening Tool and a score of 38 or higher on the Tampa Scale of Kinesiophobia. 89 Subjects were randomised to either 8 one-on-one CCBT sessions with an expert psychologist or 8 physiotherapy sessions (including some group exercise sessions).

The findings of this study suggest that CCBT is credible, acceptable and promising for people with low back pain who present with high levels of avoidance and distress. The authors believe that the effects would be greater if combined with physiotherapy.

How do we as clincians encourage patients with psychological risk factors to seek psychological intervention?

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